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Illinois State UniversityISU ReD: Research and eData
Theses and Dissertations
3-6-2015
The Effect of a Fruit and Vegetable Program onDiet Quality and Produce ConsumptionJeanne ArbuckleIllinois State University, [email protected]
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Recommended CitationArbuckle, Jeanne, "The Effect of a Fruit and Vegetable Program on Diet Quality and Produce Consumption" (2015). Theses andDissertations. Paper 334.
THE EFFECT OF A FRUIT AND VEGETABLE PROGRAM
ON DIET QUALITY AND PRODUCE
CONSUMPTION
Jeanne Arbuckle
66 Pages May 2015
Fruits and vegetables are an important part of our diet, yet few individuals
consume the recommended amounts. Incorporating produce in our diet provides many
necessary nutrients and may aid in decreasing the risk of chronic disease, controlling
obesity and improving mental functioning. In an attempt to increase intake, a program
was created to provide fresh fruits and vegetables on a weekly basis to a Midwestern
university population for eight weeks. Participants chose from three sizes of produce bags
and were supplied with seven different types of fruits and vegetables each week. Dietetic
interns performed the planning, ordering, organizing and preparing of the produce for
participants to pick up as well as managing volunteers to help with the process. The
purpose of this quantitative study was to test whether the program would increase the
consumption of fruits and vegetables for its participants or otherwise change the behavior
of the participants regarding fruits and vegetables. While individuals who were involved
in the fruit and vegetable program had an increase in both fruit and vegetable
consumption, those increases were not significant. The study also found insignificant
increases in intake of vitamin-rich vegetables (defined as broccoli, Brussels sprouts,
carrots, collards, kale, red pepper, spinach, sweet potatoes and winter squash) and leafy
green vegetables (defined as collards, kale, mustard greens, romaine lettuce, spinach, or
Swiss chard). After the study, participants were significantly more likely to consume a
lunch or dinner meal containing grains, vegetables or beans but little or no meat, poultry,
fish, eggs or cheese. An improvement in the healthy quality of participant's diets (based
on the total points available in the survey) was observed after the program, but it was not
significant. Data from Likert-style healthy eating behavior questions were also analyzed
using principal component analysis with varimax rotation. Participants perceived that
they increased fruit and vegetable consumption and improved their healthy eating
behaviors while involved in the program.
THE EFFECT OF A FRUIT AND VEGETABLE PROGRAM
ON DIET QUALITY AND PRODUCE
CONSUMPTION
JEANNE ARBUCKLE
A Thesis Submitted in Partial
Fulfillment of the Requirements
for the Degree of
MASTER OF SCIENCE
Department of Family and Consumer Sciences
ILLINOIS STATE UNIVERSITY
2015
© 2015 Jeanne Arbuckle
THE EFFECT OF A FRUIT AND VEGETABLE PROGRAM
ON DIET QUALITY AND PRODUCE
CONSUMPTION
JEANNE ARBUCKLE
COMMITTEE MEMBERS:
Julie R. Schumacher, Chair
Robert W. Cullen
Hae J. Gam
i
ACKNOWLEDGMENTS
The writer wishes to thank the committee chair, Dr. Julie Schumacher, for her
support and guidance throughout this project. The writer would also like to thank the
committee members, Dr. Hae Jin Gam for her timeliness and attention to detail, and Dr.
Robert Cullen for his insight and wisdom.
JA
ii
CONTENTS
Page
ACKNOWLEDGMENTS i
CONTENTS ii
TABLES iv
FIGURES v
CHAPTER
I. JOURNAL ARTICLE 1
Introduction 1
Methods 4
Participants 4
Program Description 4
Rate Your Diet 5
Additional Information Captured 7
Data Analysis 8
Results 8
Discussion 14
II. REVIEW OF RELATED LITERATURE 21
Extended Literature Review 21
Introduction 21
Benefits of Fruit and Vegetable Intake 21
Energy density and caloric intake 21
Satiety 23
Disease risk 24
Type 2 diabetes 24
Heart disease and stroke 25
iii
Oxidative stress 25
Cancer 26
Cognitive impairment 29
Lung diseases 29
Bone health 30
Eye diseases and conditions 31
Rheumatoid arthritis 32
Overweight and obesity 33
Optimal Intake 33
Current Intake 35
Comparison Between Optimal and Current Intake 36
Possible Causes of Discrepancy Between Optimal and
Current Intake 36
Community Supported Agriculture 39
REFERENCES 42
APPENDIX A: Recruitment Email 54
APPENDIX B: Consent Form 55
APPENDIX C: Pre-Survey 57
APPENDIX D: Additional Post-Survey Questions 66
iv
TABLES
Table Page
1. Points for Fruit and Vegetable Servings 10
2. Points for Vitamin-Rich Vegetable Servings 11
3. Points for Leafy Green Vegetable Servings 11
v
FIGURES
Figure Page
1. Gender of Participants in the Fruit and Vegetable Program 9
2. Age Group of Participants in the Fruit and Vegetable Program 9
3. University Status of Participants in the Fruit and Vegetable Program 10
4. Participants Reported Number of Times Per Week Their Lunch or Dinner
Contained Grains, Vegetables, or Beans, but Little or No Meat, Poultry,
Fish, Eggs, or Cheese 12
5. Healthy Eating Behaviors of Fresh FAVs Participants 14
1
CHAPTER I
JOURNAL ARTICLE
Introduction
Fruit and vegetable consumption offers many acknowledged benefits, such as the
diverse assortment of necessary nutrients including vitamins, minerals, fiber and
phytochemicals as well as assistance in the prevention of a variety of chronic diseases
(Liu, 2013). In addition, it has been shown that higher intakes of fruit and vegetables
could lower calories consumed, increase satiety and help manage weight (Boeing et al.,
2012). Despite all these reasons to consume a wide variety of fruits and vegetables,
consumption is far below what is considered optimal in the United States (Krebs-Smith,
Guenther, Subar, Kirkpatrick, & Dodd, 2010).
The State Indicator Report on Fruits and Vegetables revealed that among US
adults, 32.8% consumed at least two servings of fruit per day and 27.4% of adults
consumed at least three servings of vegetables per day. This research also determined that
32.2% of adolescents had an intake of at least two servings of fruit and 13.2% ate three or
more servings of vegetables per day. Additionally, it was reported that only 14% of
adults consumed both two or more servings of fruits and three or more servings of
vegetables. The number of adolescents reaching those goals was lower at 9.5% (Centers
for Disease Control and Prevention, 2009). In a more recent article, the Centers for
Disease Control and Prevention confirmed a 67% increase in the amount of fresh, frozen
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or canned fruit not including juice consumed by children (in child care, Head Start,
preschool or pre-kindergarten) 2-18 years old, during 2003-2010. No improvement
occurred in the amount of vegetables children ate from 2003 to 2010. Moreover, during
2007-2010, 90% of children did not consume the recommended amount of vegetables
(Centers for Disease Control and Prevention, 2014). According to the Produce for Better
Health Foundation, adult males averaged 1.37 cups of vegetables and 0.71 cups of fruit
per day in 2009. The same report found that adult females consumed 1.11 cups of
vegetables and 0.65 cups of fruit on the average day. Further, the report found that
children’s intake averaged 0.80 servings of vegetables and 0.69 servings of fruit per day
(Produce for Better Health Foundation, 2010).
Many factors contribute to the low intake of fruits and vegetables, including the
expense and limited availability of high quality fresh produce. Farmers markets have
been established to supply fresh fruits and vegetables directly from the farmer, increasing
the freshness and appeal. Some farmers also provide produce in a format called
community supported agriculture (CSA). These programs offer a share of the farm
outputs, usually in the form of weekly produce distribution, for a specified number of
weeks in return for an up-front payment. Landis, Smith, Lairson, Mckay, Nelson, &
O’Briant, (2010) found that a CSA membership was associated with consumption of a
larger number and wider variety of fruits and vegetables compared to that of individuals
with similar sociodemographic characteristics who did not belong to a CSA.
In order to increase the quantity of fruits and vegetables in the diets of students,
faculty, staff and retirees of a large Midwestern university, a program named Fresh FAVs
(for fruit and vegetable) was created to supply weekly produce to participants. This
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program provided fresh fruits and vegetables direct from a wholesale distributor. Because
the path from producer to consumer was shortened, the produce was fresher than that
found in some grocery stores. In addition, the program used volunteers to supply the
labor, lowering the cost. Affordability of the produce was also increased by the quantity
discount afforded by the university’s volume purchased.
Some characteristics of Fresh FAVs were similar to CSA programs. In both cases,
participants chose the quantity they wished to receive each week and paid prior to the
start of the program. Another common characteristic was the division of the available
produce proportionately based on the size of the “bag” purchased. Produce was
distributed weekly from a central location, as is common with CSA’s. Unlike a CSA,
however, produce was obtained from a vendor who purchased from many different farms,
few if any of whom were local. CSA members usually join due to environmental
concerns, desire for organic or local produce, support for the local economy, to gain
knowledge of where food comes from and how it was grown, or as a source for fresh
produce. The fruit and vegetable program studied in this study was a source for fresh
produce but did not resolve any of the other concerns mentioned.
The purpose of this quantitative study was to test whether a fresh fruit and
vegetable program would increase the consumption of fruits and vegetables for its
participants. This study focused on the following hypotheses:
1. Participants in the program would consume more fruits and more vegetables while they
were participants in the program than consumed prior to the program.
2. Participants in the program would consume more vitamin-rich vegetables including
broccoli, Brussels sprouts, carrots, collards, kale, red pepper, spinach, sweet potatoes, and
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winter squash during the program as compared to their consumption level before
beginning the program.
3. Participants would consume more leafy green vegetables including collards, kale,
mustard greens, romaine lettuce, spinach, and Swiss chard for the duration of the program
compared to their intake before the program.
4. The fruit and vegetable program would inspire people to consume a healthier diet,
including adequate amounts and variety of fruits, vegetables, whole grains, lean meats,
and low-fat dairy; and limited amounts of fried foods, sugar, sodium and unhealthy fats.
Methods
Participants
A purposive sample of the fresh fruit and vegetable program participants (N=179)
was recruited to participate in an online survey before the initial week of the program and
after the last week of the program. The survey required the participant to complete an
electronic informed consent document before answering the survey questions. The initial
survey was conducted in February, 2014 before the beginning of the fruit and vegetable
program, and the follow-up study was conducted in April 2014 at the conclusion of the
program. All procedures were reviewed and approved by the University’s Institutional
Review Board (IRB).
Program Description
Fresh FAVs was developed and administered by students in the dietetic internship
program under the supervision of the program director. Participants were recruited from
students, faculty, staff, and retirees of a Midwestern public university. Prior to the
program’s start, each participant purchased a small (intended to feed one to two people),
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medium (for three to four people), or large (for five to six people) produce package. The
money from the participants was used to create a weekly budget for purchasing produce
over the eight weeks of the program. Produce was provided on a weekly basis eight times
during the last half of the spring semester. Each week, four varieties of fresh vegetables
and three varieties of fresh fruits were purchased from the company that supplied food to
the dining centers of the university in quantities sufficient to fill the packages
proportionally, but still stay within the budget. Factors considered in determining the type
of produce to purchase included color, size, budget, availability, and amount of work
necessary to separate the produce into appropriate individually packaged portions. One
expensive item, one unusual item, and one to two items requiring packaging were chosen
each week. . Once the items were determined for the week’s package, two recipes using
the some of the produce to be provided were emailed to the participants.
Once the produce arrived on Fridays, volunteers assisted the dietetic interns in
counting, dividing and setting up the produce for pick up by the participants. There were
two designated pickup times of one and one-half hours each on the designated day each
week, from 12-1:30 P.M. and 3:30-5 P.M. Volunteers also assisted interns during pick up
times. Excess produce was donated to a local residential treatment center for children or
the local mission that served the homeless and hungry.
Rate Your Diet
The survey instrument chosen for this study was used to measure the healthiness
of a participant’s overall diet. It was created by the Center for Science in the Public
Interest (CSPI). Permission was granted by CSPI in writing for use of the instrument.
The original survey was titled Rate Your Diet. It assigned a point value to each answer.
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Possible scores for each of the 39 questions had varying ranges from -4 to +3, with lower
scores indicating healthier choices. Total points for the survey ranged from -119 to +113.
The Rate Your Diet Survey is similar to a food frequency questionnaire in that it
measures the types and quantities of food the survey-taker typically consumes. Questions
in the survey were divided by category. The fruits, vegetables, grains, and beans category
included questions about the number of servings of fruit juice, fruits, vegetables, grains
and beans typically consumed. Types of vegetables, breads, and cereals commonly eaten
were queried. Questions in the meat, poultry, and seafood category measured the
frequency of high-fat and lean red meat consumption, the size of red meat servings, and
whether fat was trimmed from red meat. In addition, information was requested about the
types of ground meat, chicken parts, and varieties of seafood normally consumed; and
whether skin was removed from poultry before it was eaten. Questions about mixed foods
determined the survey-taker’s most typical breakfast, types of sandwich fillings, toppings
for pizza and pasta, salad dressings, and salad toppings. The mixed food category also
asked about the quantity of egg yolks as well as the number of servings of cheese and
low-fat calcium-rich foods consumed. The fats and oils category included questions to
determine the type of condiments used on breakfast breads, sandwiches, and salads made
with pasta and meat. This section also asked about the use of butter, margarine, and oils
for cooking. The questions in the beverages section were intended to identify the most
common beverages consumed and the types of fruit beverages and milk the respondent
drinks. The last section included questions about snacks including salty snacks, cookies,
cakes, pastries, and frozen desserts. Each answer had a point value assigned to it. The
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intention of the original survey was to sum the points from each question to calculate a
score which determined the healthiness of a person’s dietary habits.
In the researchers’ survey, the respondent was given the question and possible
answers, but the point values were assigned by the software without showing the points
assigned to the answers on the screen. The intention of the researchers was that the
survey-taker remain unaware of the points being assigned and calculated in the
background in order to prevent bias. Some of the questions from the original survey
directed the respondent to add or subtract from the question’s original points if foods
were consumed in a certain way. For example, the original question may ask about
servings of pizza, and direct the survey-taker to add points for extra cheese. To alleviate
the respondents from calculating these points, additional questions were added to the
survey to identify these behaviors and assign the appropriate point values. Total points
were calculated to determine the healthy quality of participants’ diets. The same
questionnaire was administered to the fruit and vegetable program participants before the
program and at the conclusion of the program.
Additional Information Captured
In addition to the questions from the Rate Your Diet survey, demographic
information including gender, age group, campus relationship (faculty, staff, student or
retiree), and departmental affiliation was captured. Six Likert-type items developed to
measure the improvement of healthy eating behaviors after program participation were
also included in the follow-up survey. These items were reviewed by a committee of
nutrition professors and statisticians for content and face validity. Further, they were used
in factor analysis to assess the value of the program.
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Data Analysis
Descriptive statistics were used to compute the frequencies, means, and standard
deviations of the servings consumed before and after the intervention. To identify the
difference between fruit and vegetable consumption before and after the program, paired
samples t-tests were conducted. In order to determine construct validity of measurement
with multiple items, principal component analysis with varimax rotation was conducted.
Constructs with factor loadings of items above .55 and not higher than .30 on the other
factors were considered valid. Internal reliability of each measurement was also
evaluated through Cronbach’s standardized alpha values; when the alpha values were
above .70, the items were retained for further analysis. All statistical analyses were
conducted using IBM SPSS Statistics software (version 20, 2011, IBM Corporation,
Somers, NY).
Results
A total of 140 (78.2%) pretests and 130 (72.6%) posttests were collected from the
179 Fresh FAVs participants. Eighteen pretests and twelve posttests were excluded from
analysis due to incomplete responses. Of the 122 pretest respondents, 78.7% were female
(n=96), 18.0% were male (n=22), and 3.3% (n=4) of the participants did not respond to
the gender question (see Figure 1). More females (81.4%; n=96) than males (18.6%;
n=22) also responded in the posttest. The participants were divided into six age groups as
described in Figure 2.
The study also captured the type of association the participants had with the
university (Figure 3). In the pretest, there were 23 (18.9%) faculty, 75 (61.5%) staff, 10
(8.2%) undergraduate students, 7 (5.7%) graduate students, 3 (2.5%) retirees and 4
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(3.3%) participants who left the field blank. In the posttest, there were 23 (19.4%)
faculty, 79 (66.9%) staff, 6 (5.1%) undergraduate students, 5 (4.2%) graduate students,
and 5 (4.2%) retirees. The follow-up survey incorporated additional questions which
addressed participants’ perceptions of the effect of the program on their food-related
behaviors.
Figure 1. Gender of Participants in the Fruit and Vegetable Program
Figure 2. Age Group of Participants in the Fruit and Vegetable Program
0
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80
100
120
Male Female Unknown
Nu
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Initial Survey
Follow-up
0
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Initial Survey
Follow-up
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Figure 3. University Status of Participants in the Fruit and Vegetable Program
Prior to the program, participants estimated their usual fruit intake at less than two
servings per day (M = 0.84, SD = 1.226, see Table 1) and vegetable intake at
approximately two servings per day (M = 1.07, SD = 1.159, see Table 1). After the study
was complete, people who participated in the program estimated their average
consumption at just over two servings of fruit (M = 1.14 points, SD = 1.226 points) and
slightly more than two servings of vegetables (M = 1.18 points, SD = 1.159) per day.
Intake of both fruits and vegetables increased from participants’ original estimates;
however, the changes were not significant (t=1.81, p=.72; t=.658. p=.511).
Table 1. Points for Fruit and Vegetable Servings
Servings Points
0 -3
less than 1 -2
1 0
2 1
3 2
4 or more 3
0
10
20
30
40
50
60
70
80
90
Nu
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art
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Initial Survey
Follow-up
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Program participants averaged four to six vitamin-rich vegetable servings (M =
1.63 points, SD = 1.061 points, see Table 2) per week at the end of the program. This was
an average increase of 0.28 points, but not a significant difference. The vitamin-rich
vegetables included broccoli, Brussels sprouts, carrots, collards, kale, red pepper,
spinach, sweet potatoes, or winter squash. Participants also stated that they averaged one
to two servings of leafy greens (M = 1.16 points, SD = 1.674 points, see Table 3) per
week, including collards, kale, mustard greens, romaine lettuce, spinach, or Swiss chard.
Table 2. Points for Vitamin-Rich Vegetable Servings
Servings Points
0 -3
1 to 3 1
4 to 6 2
7 or more 3
Table 3. Points for Leafy Green Vegetable Servings
Servings Points
0 -3
less than 1 -2
1 to 2 1
3 to 4 2
5 or more 3
After the study, participants were significantly more likely (t= 2.12, p = .035) to
consume a lunch or dinner meal containing grains, vegetables or beans but little or no
meat, poultry, fish, eggs or cheese. This is the only produce-related question from the
Rate Your Diet portion of the survey to show significant results for the entire population.
The other questions measuring fruit and vegetable intake showed insignificant increases,
as previously explained. An improvement in the healthy quality of participants’ diets
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(based on total points) was observed after the program, but it was not significant
(t=.1.938, p=.054).
Figure 4. Participants Reported Number of Times Per Week Their Lunch or Dinner
Contained Grains, Vegetables, or Beans, but Little or No Meat, Poultry, Fish, Eggs, or
Cheese
After separating data by gender, a paired samples t-test compared data from the
survey taken before the program to data from the survey taken at the conclusion of the
program. This assessment found no difference between males and females with regard to
the likelihood of consuming a meal containing grains, vegetables or beans but little or no
meat, poultry, fish, eggs or cheese (F=.645, p=.587) (Figure 4). An independent samples
t-test compared the difference between males and females for all of the “Rate Your Diet”
questions in the survey. It was found that women consumed significantly more vitamin-
rich vegetables (M=1.58; SD=1.063) than men (M=1.07; SD=1.634) (t=2.533, p=.011).
While females averaged a higher consumption of fruit, vegetables and leafy green
vegetables, these numbers were not significant (t=1.258, p=.209; t=1.928, p=.055).
0
10
20
30
40
50
60
0 1 to 2 3 to 4 5 or More Unknown
Nu
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f P
art
icip
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ts
Initial Survey
Follow-up Survey
13
Point scores for the five questions that were most closely related to fruit and
vegetable consumption were totaled. The means of the total fruit and vegetable
consumption score were compared by gender using an independent samples t-test. No
significant difference was found between males and females.
Linear regression was used to determine whether participants’ fruit and vegetable
consumption affected the healthy eating behaviors. Results showed that these variables
were positively related (F(1,124) = .014, p > .05), but were not statistically significant.
Overall, participants felt an improvement in the healthiness of their diet due to their
participation in the program; however, there were no gender differences related to this
improvement.
Data from the healthy eating behavior questions (Figure 5) were also analyzed
using principal component analysis with varimax rotation. Participants perceived that
they increased fruit and vegetable consumption and improved their healthy eating
behaviors while involved in the program. Eighty-six percent of participants agreed or
strongly agreed that the program had a positive effect on their attitude about fruits and
vegetables, while only 14% disagreed (0.8%), strongly disagreed (1.6%), or were neutral
(12%). Similarly, 88% of participants agreed or strongly agreed that Fresh FAVs inspired
them to consume more fruits and vegetables. Likewise, 82.5% of participants agreed or
strongly agreed with the statement “Fresh FAVs inspired me to consume more healthy
food.” Slightly fewer (78.5%) agreed or strongly agreed that the program inspired them
to locate and use new recipes. Conversely, only 54% agreed or strongly agreed that Fresh
FAVs inspired them to learn new methods of cooking.
14
Figure 5. Healthy Eating Behaviors of Fresh FAVs Participants
Discussion
The purpose of this study was to test whether participants would increase their
consumption of fruit, vegetables, vitamin-rich vegetables and leafy greens after
participation in the Fresh FAVs program. There was an increase, but not significant, for
each produce group, demonstrating the effectiveness of the program. In addition, this
research also measured whether the program could inspire people to improve the healthy
quality of their diet, defined as including adequate amounts and variety of fruits,
vegetables, whole grains, lean meats, and low-fat dairy; and limiting fried foods, sugar,
sodium and unhealthy fats. Results of the study showed that participants significantly
increased the number of meals including mostly plant-based foods with minimal animal-
based foods. In order to use all the produce provided by Fresh FAVs, participants may
0
10
20
30
40
50
60
70
Fresh FAVs
had a positive
effect on my
attitude about
fruits and
vegetables.
Fresh FAVs
inspired me to
consume more
fruits and
vegetables.
Fresh FAVs
inspired me to
consume more
healthy food.
Fresh FAVs
inspired me to
locate and use
new recipes.
Fresh FAVs
motivated me
to learn new
methods of
cooking.
After
participation
in Fresh
FAVs, I will
continue to
consume a
wider variety
of produce.
Strongly Disagree Disagree Neutral Agree Strongly Agree
15
have purchased amounts of other foods smaller than their normal purchase amount,
resulting in the higher quantity of plant-based foods in participants’ diets. The study also
found a non-significant improvement in the overall healthy quality (based on total points)
of participants’ diets.
The majority of Fresh FAV’s participants who responded to the survey were
female, including 79% in the pretest and 81% in the posttest. Results from the study
showed that women consumed more fruits, vegetables, and leafy greens than men, but
these numbers were not significant. Moreover, women consumed significantly more
vitamin-rich vegetables than men. Bellavia, Larsson, Bottai, Wolk, & Orsini (2013) also
found that women consumed more servings of fruit and vegetables than men. Similarly,
in a study by Lazzeri et al., (2013), adolescent females reported higher consumption
levels of both fruit and vegetables than adolescent males. This may indicate that women
are more likely to incorporate produce in their diet than men. However, there was no
gender difference related to participants’ perception of improvement in the healthiness of
their diet. This may indicate that men are less concerned about including fruits and
vegetables in their diet.
Most participants agreed that the program improved their attitude about and their
intake of fruits and vegetables, as well as increasing their intake of healthy food in
general. More than 75% felt the program inspired them to locate and use new recipes, and
slightly over half believed the program inspired them to learn new methods of cooking.
This strong evidence shows that the program improved skills for planning and
preparation of healthy meals as well as inspiring positive behavior change in most of the
16
people involved during the program. However, the study did not determine whether this
behavior change continued after the conclusion of the program.
This study may be valuable to others hoping to create a successful program to
increase fruit and vegetable consumption, whether in a University setting or in other
venues. A review of current literature found no reports of similar programs in University
settings, although a model for a University CSA exists (Wharton & Harmon, 2009). The
information from this research may also be useful in improving the program in the future.
There were many advantages to the program. First, it was located on the campus
where most of the participants either took classes or worked, allowing easy and
convenient access to the pick-up location. Likewise, two different pick-up times were
offered for a total of three hours, maximizing the times pick-up was available. In
addition, produce was limited to seven items to avoid overwhelming the participants with
excess produce or expense. The fruit and vegetable bags were offered in three sizes in
order to tailor the bag to family size or offer the opportunity for sharing a bag.
Furthermore, recipe ideas were offered by email, and a Facebook page was created to
allow participants to share ideas for using the produce. Because the vendor had a contract
with the University, the produce was offered at a price competitive with or better than
local grocery stores. Additionally, participants were exposed to fruits and vegetables that
many were unfamiliar with, such as fennel, kale and eggplant, and might not have
purchased on their own, providing the opportunity to gain familiarity with new types of
produce. Unwanted and excess produce was donated to disadvantaged groups who have
limited opportunities to consume a wide variety of fresh produce. The program was an
17
excellent leadership experience for the dietetic interns who administered the program, as
well as a volunteer opportunity for many students.
However, there were a few disadvantages noted by participants and one
frequently expressed by individuals who did not enroll in the program prior to the
deadline. Participants frequently requested a list of produce to be supplied for the week to
assist in their grocery planning, but the program was unable to provide this information
until the shipment was verified by the vendor a day or two before delivery. Furthermore,
the requirement for the money to be paid for the entire eight week program prior to its
inception was a disadvantage for those on a limited budget. In addition, people were
unable to join the program once it had begun for the semester as the budget for each week
had already been determined.
The Fresh FAV’s population had some similarities with CSA populations, but
demographic data captured about participants was limited. Past studies have identified
CSA populations as likely to be mostly Caucasian, highly educated, and have a higher
than average income (Cohen, Gearhart, and Garland, 2012; Landis, et al., 2010; Russell
and Zepeda, 2008; Uribe, Winham, and Wharton, 2012). The survey used for this study
did not capture race, education level or income level of the survey population, making it
difficult to compare the study’s population in these categories; however, as all of the
population had some affiliation with a University, it is likely that they also were more
highly educated than the general population. Program participants in two CSAs were
more than 80% female (Cohen, et al., 2012; Uribe, et al., 2012); 78% of Fresh FAV’s
participants surveyed were also female. Furthermore, other studies had an average age of
35.9 (+/– 10.0) (Cohen, et al., 2012), 42 (Uribe, et al., 2012), 43.7 (Landis, et al., 2010),
18
and 47 (Russell and Zepeda, 2008). The average age of a Fresh FAV’s participant was
not calculated; however the participants were fairly evenly distributed over the age
groups 28-37 (24%), 38-47 (19%), 48-57 (23%) and 58-67 (19%), showing that
participants of the fruit and vegetable program most likely had a slightly higher average
age.
This study has several limitations that should be taken into consideration when
interpreting the results. Due to the convenience sample which was limited to participants
who were willing to spend money and effort to participate in the program, the results of
the study may not be generalizable to the entire population. In addition, participants in the
program are likely people who already have some familiarity with including fruits and
vegetables in their diet. The results might be different if the population included people
with limited expertise with produce. In addition, the data captured for this study occurred
at one point in time, at the conclusion of the eight week program. It is unknown whether
behaviors changed during the program would continue to occur after the conclusion of
the program. Therefore, the long-term effectiveness of the program is unknown.
Furthermore, the study was limited by the demographic information captured.
Additionally, the study did not capture the variety of fruits and vegetables consumed.
Data was not available to thoroughly describe the participants and be able to compare
them with other studies. The survey used in the study was another weakness. Responses
to some of the questions measured servings in ranges, such as one to three servings or
four or more servings, which made it impossible to identify the exact number of servings
consumed, and consequently complicated statistical analysis. Responses with a direct
19
correlation between the number of servings consumed and the number of points assigned
would have improved the ability to generate meaningful statistics.
Future directions may include exploring ways to address the long-term
effectiveness of the program. The current study did not measure whether behavior change
continued beyond the conclusion of the program. It may also be valuable to determine
whether there is an increase in the variety of produce consumed after participation in the
Fresh FAV’s program. Investigating barriers to consumption associated with the program
is another possibility for additional research. Wharton and Harmon (2009) mentioned that
campus-based CSAs might have an impact on health by changing attitudes, as well as
improving food skills and eating behaviors of participants, especially students. This could
also apply to the fruit and vegetable program, and it might be of interest to measure the
student impact of a similar program with a larger student population.
In conclusion, participants increased their consumption of fruits, vegetables,
vitamin-rich vegetables and leafy greens after the program, but not at a significant level.
The healthy quality of participants’ diets also improved, but insignificantly. Results
showed that women improved their diets in all these categories at a greater level than
men. Moreover, there was a significant increase for all participants in the meals
consumed containing mostly plant-based foods with limited animal-based foods.
Improved attitudes and healthy behaviors related to fruits, vegetables, and healthy eating
were also reported for all participants at the conclusion of the program.
Advantages of the program included a convenient method of increasing the fruits
and vegetables in participants’ diets, provision of recipe and preparation suggestions,
reasonable cost, the opportunity to try new foods, the chance to donate to underprivileged
20
groups, and the opportunity for student leadership and volunteer experiences. The
inability to inform participants of the produce they would receive early in the week was
one disadvantage for many enrolled in the program. Paying for all eight weeks before the
program started and the inability to allow new participants after the program began were
also problematic for some. However, the participants reported that the program was very
valuable overall in improving their fruit and vegetable consumption.
21
CHAPTER II
REVIEW OF RELATED LITERATURE
Extended Literature Review
Introduction
Fruits and vegetables are an important part of one’s daily diet, yet few people
consume them in the recommended amounts. Lutfiyya, Chang, and Lipsky (2012) found
that 78.8% of rural US adults and 75.6% of non-rural US adults consumed less than five
servings of fruits and vegetables per day. MyPlate recommends three to five cups of fruit
and vegetables per day (USDA, n.d.). Servings of most fruits and vegetables are
generally counted in one-half cup increments, so three to five cups would be six to ten
servings (American Heart Association, 2015).
There are many benefits acquired from meeting the recommended amount of
fruits and vegetables per day. Among these benefits are decreased calorie intake,
increased satiety, provision of important nutrients, prevention of certain chronic diseases,
and decreased risk of overweight/obesity. In addition, fruits and vegetables provide a
wide array of colors on the plate, making food more visually appealing.
Benefits of Fruit and Vegetable Intake
Energy density and caloric intake. The Centers for Disease Control and
Prevention (CDC) define energy density as the calories contained in a specific weight of
food (CDC, n.d.a). Energy density may affect the balance of energy intake with energy
22
expenditure and consequently, the ability to maintain current body weight. Foods that are
low in energy density, such as fruits and vegetables, may help people decrease their
energy intake and promote a healthy weight (Hackett, 2012). Foods with high energy
density may cause consumption of excess calories, therefore promoting weight gain and
leading to obesity (Prentice and Jebb, 2003). Increasing the fruits and vegetables in a
meal may lower the energy density and permit consumption of larger, more satisfying
portions while maintaining or decreasing the energy level, thus improving weight
management (Rolls, Ello-Martin, and Tohill, 2004).
Including fruits and vegetables in meals can help lower the energy density of
meals. Considerable weight loss has been associated with diets having lower energy
density due to the addition of water-rich foods such as fruits and vegetables (Rolls, 2009).
These lower energy-density diets are thought to assist in weight loss as people tend to
decrease their energy intake despite the lack of limits on consumption (Rolls, et al.,
2004). Since people usually consume food with a similar weight, reducing the energy
density may also reduce caloric intake (Rolls, 2009). Studies have also shown that the
addition of pureed vegetables reduced energy density of foods and decreased energy
intake (Spill, Birch, Roe, and Rolls, 2011; Vale, Schumacher, Cullen, and Gam, 2014).
According to Rolls (2009), water decreases the caloric value of foods because it
adds weight to the food without adding energy. Nearly all fruits and vegetables contain
large quantities of water. Rolls, et al. (2004) attribute the lower energy density in fruits
and vegetables mostly to the high quantity of water and low amount of fat present,
although the fiber contained in produce also lowers the caloric value.
23
Satiety. Satiety is the body’s physiological response to adequate consumption of
food (McGuire and Beerman, 2011). Increased satiety is another benefit attributed to the
intake of fruits and vegetables. Rolls, et al. (2004) believe increased satiety is due to the
reduced energy density, increased fiber content and glycemic index of fruits and
vegetables. Rolls (2009) determined that reduced energy density in foods such as fruits
and vegetables may increase satiety by delaying gastric emptying.
Some studies have identified that larger quantities of fiber increase satiety and
reduce consumption of calories (Rolls et al., 2004). A meta-analysis by Clark and Slavin
(2013) determined that some fibers may have a stronger impact on satiety than others.
Savastano, Hodge, Nunex, Walker, and Kapikian (2014) investigated the impact of fiber
on energy intake and satiety and found that the groups consuming the extra fiber had
decreased energy intake and increased satiety when compared to the control group.
Harrold et al., 2013, also observed that fiber consumed 15 minutes before meals
significantly decreased caloric intake during the meal.
Glycemic index has been defined by the American Diabetes Association (2014) as
a number used to compare how foods with carbohydrates affect blood sugar. Many
studies researching the effects of glycemic index on satiety have conflicting results
(Bornet, Jardy-Gennetier, Jacquet, and Stowell, 2007; Burton-Freeman and Keim, 2008;
Wolever, Leung, Vuksan, and Jenkins, 2009; Papadaki, et al., 2010). In a review of recent
research, Jones determined that the impact of the glycemic index on satiety may vary
based on the participant’s personal characteristics. Furthermore, Jones (2013) suggests
that the varied ways of measuring satiety may be responsible for the conflicting results
among studies. The variation in glycemic index among vegetables may also have an
24
impact on the differing outcomes. However, glycemic index is another possible
mechanism that assists fruits and vegetables in impacting satiety.
Disease risk. Consumption of fruits and vegetables may protect against a number
of chronic diseases. Elevated levels of fruit and vegetable intake have been associated
with a decreased frequency of chronic disease related to obesity, such as type two
diabetes and cardiovascular disease. In addition, Bellavia, et al. (2013), found a
relationship between intake of less than five servings of fruits and vegetables per day and
higher overall mortality rates. Possible evidence was found to indicate that higher intakes
of fruits and vegetables reduce the risk of dementia and preclude increased weight.
Another benefit indicated by this research is a lower risk of some eye diseases,
rheumatoid arthritis, osteoporosis, asthma and COPD with an increase in consumption of
fruits and vegetables (Boeing, et al., 2012).
A current research study investigating ideal consumption levels for the general
population in England determined that the lowest mortality rate occurs with individuals
who consume at least seven servings of fruits and vegetables. For this study, servings
were defined as 80 grams (slightly more than one-half cup), as determined by NHS
England (Oyebode, Gordon-Dseagu, Walker, & Mindell, 2014). Another recent study
concluded that each additional portion of fruit decreased risk of death by 6% and each
additional portion of vegetables decreased the risk of death by 5% up to five servings per
day (Wang, Ouyang, Liu, Zhu, Zhao, Bao, & Hu, 2014).
Type 2 diabetes. Lambrinoudaki et al. (2012) stressed the importance of eating
patterns high in fruits and vegetables as part of a healthy diet helpful in the prevention of
type 2 diabetes (T2D) and other chronic diseases. Moreover, two meta-analyses found an
25
association between an increased intake of leafy green vegetables and a significant
decrease in the risk of T2D (Carter, Gray, Troughton, Khunti and Davies, 2010; Li, Fan,
Zhang, Hou, & Tang, 2014). The study by Li, et al. (2014) determined that consuming
more fruit may also lower the risk of T2D. A study investigating fruit and vegetable
intake in patients with T2D also found that increased consumption produced higher levels
of carotenoid and the enzymes associated with the antioxidant function of HDL,
suggesting that an increase in fruits and vegetables consumed may help lower the risk of
T2D and related cardiovascular disease (Daniels, et al., 2014).
Heart disease and stroke. Studies show that fruits and vegetables decrease the
risk of cardiovascular disease. In a review of several studies, Boeing, et al. (2012), found
convincing evidence that consumption of fruits and vegetables may assist in the
prevention of hypertension, heart disease and stroke. Similarly, Bhupathiraju et al. (2013)
determined that an inverse relationship existed between consumption of more of fruits
and vegetables and risk of heart disease. In an Italian cohort study, Bendinelli et al.
(2011) substantiated a lower risk of coronary heart disease for individuals consuming
larger quantities of leafy green vegetables. Finally, He, Nowson, Lucas and MacGregor
(2007) determined that participants in a number of cohort studies who consumed more
than five servings of fruits and vegetables had a 17% lower risk of coronary heart disease
when compared to those who consumed less than three servings per day.
Oxidative stress. Oxidative stress occurs when there are more free radicals and
reactive species than antioxidants can defend against, and may increase the risk of
chronic diseases such as coronary artery disease and T2D (Cocate et al., 2014).
Antioxidants are found in a wide variety of fruits and vegetables (Wood, et al., 2012). In
26
a recent cross-sectional study, Cocate et al., observed that a higher consumption of fruits
and vegetables was associated with reduced oxidative stress markers. Cocate et al. (2014)
also found that fiber, vitamin C, and magnesium from fruits and vegetables played an
important part in lowering oxidative stress markers. Other recent studies reported similar
results (Meyer, 2013; Hermsdorff, et al., 2012).
Cancer. There is extensive conflicting information about cancer and its
relationship to fruit and vegetable intake. Some cancers appear to be less prevalent in
populations who consume high amounts of fruits and vegetables while others are not
affected. The many different forms and locations of cancer may play a part in the
apparent lack of consistent results. Boffeta, et al. (2010) found a small relationship
between a decreased risk of overall cancer and consumption of high amounts of fruits and
vegetables. However, this was considered to be very weak evidence. Conversely,
Boeing, et al. (2012) reported probable evidence that cancer risk decreases as intake of
fruits and vegetables increases. The seemingly conflicting evidence may be due to the
difference in how various forms of cancer react to individual nutrients and the difficulty
in summarizing all those differences into one statement.
Many studies tie abundant fruit and vegetable intake to a lower risk of a variety of
cancers, sometimes with other factors included. For example, Hardin, Cheng and Witte
(2011) found that diets high in fruits and vegetables and low in foods with a high
glycemic index decreased the risk of acquiring more aggressive prostate tumors.
Conversely, in a prospective cohort study Takachi, et al. established that prostate cancer
may not be related to fruit and vegetable intake. In their review of previous related
research, Takachi, et al. determined that few studies found an inverse association between
27
prostate cancer and an increased consumption of fruits and vegetables, and their research
supported this position. However, the possibility of detection bias could not be ruled out
in this research (Takachi, et al., 2010).
Limited research was available to explain the association of fruit and vegetable
consumption with pancreatic cancer. One study by Lin, et al. (2006) observed a 50%
reduction in the relationship of high fruit consumption with the probability of pancreatic
cancer. In addition, pancreatic cancer risk was found to be lowered by most nutrients
acquired through consumption of fruits and vegetables (Jansen, et al., 2013). Likewise,
the possibility of pancreatic cancer was determined to be less likely in individuals who
consumed large quantities of fruits and vegetables (Jansen, et al., 2011).
Moreover, Lahmann, Ibiebele, Webb, Nagle and Whiteman (2014) concluded that
there is a decreased risk of esophageal cancer with higher fiber consumption. Conversely,
Adair, Hoy, Dettrick and Lopez (2011) found a weak relationship between fruit and
vegetable consumption and esophageal cancer. The same study discovered a much
stronger association with pharyngeal cancer.
Ovarian cancer is another form whose association with fruit and vegetable
consumption has produced inconsistent results in research studies. Tang, Lee, Su, and
Binns (2014) observed a decrease in the incidence of ovarian cancer in southern Chinese
women when fruit and vegetable intake increased. Additionally, intake of cruciferous
vegetables was determined to lower the risk of ovarian cancer (Han, Li, and Yu, 2014).
However, a prospective cohort study by Xie, et al. (2014) found little connection between
fruit and vegetable intake and the risk of ovarian cancer.
28
Lung cancer studies also provide a variety of results. One study in Iran
determined that fruits were protective against lung cancer (Hosseini, et al., 2014).
Another study found the same relationship between fruit consumption and lung cancer
only in smokers (Bradbury, Appleby, and Key, 2014). Tang, et al. (2010) also found that
a high intake of cruciferous vegetables was associated with a decreased risk of lung
cancer in smokers. Furthermore, consumption of green leafy vegetables, vegetables high
in beta-carotene, and watermelon were found to lower the risk of lung cancer (Takata et
al., 2013).
A meta-analysis determined that a diet high in fruits and vegetables may help
decrease the likelihood of gastric cancer (Massarrat and Stolte, 2014). A pooled analysis
of four large Japanese cohort studies also found a decrease in the risk of gastric cancer
related to vegetable intake but not fruit intake (Shimazu et al., 2014). Conversely, Wang,
et al. (2014) determined that fruit intake but not vegetable intake was associated with a
decreased the risk of gastric cancer in a meta-analysis of 24 cohort studies.
Vieira, et al. analyzed 15 research studies, resulting in a determination that there
is no relationship between the risk of bladder cancer and consumption of total fruit, total
vegetables and total fruit and vegetables. After adjusting for smoking status, one study
demonstrated an inverse association. However, certain individual fruits and vegetables
were inversely associated with a decreased risk. Citrus fruits were significantly associated
with a reduced risk of bladder cancer until one study was removed. Cruciferous
vegetables were also inversely associated with a decreased risk in a small number of
observations (Vieira, et al., 2014). Similarly, a meta-analysis of case-control and cohort
studies observed a relationship between consumption of citrus fruit and a smaller risk of
29
bladder cancer (Liang, Lv, Chen, Jiang, and Wang, 2014). Thus, it seems clear that fruits
and vegetables may be beneficial for some types of cancer.
Cognitive impairment. There have been several studies investigating the
relationship of fruit and vegetable intake with various types of cognitive impairment.
Lamport, Saunders, Butler, and Spencer (2014) reported that frequent intake of fruits,
vegetables and juices over a lifetime had a positive impact on comprehension in healthy
older adults and may be protective against cognitive aging and dementia. In a study by
Kesse-Guyot, Andreeva, Lassale, Hercberg, & Galan (2014), limited intake of fruits and
vegetables were one of the unhealthy behaviors associated with reduced verbal memory.
Park, You and Chang (2010), found that nutrients such as vitamin A, beta carotene,
vitamin C, fiber and folate could be lacking in people with depression. Additional studies
found that diets high in fruits and vegetables were protective against depression
(Akbaraly et al, 2009; Samieri et al., 2008). In a meta-analysis by Sanhueza, Ryan, &
Foxcroft (2013), a lower risk of depression was indicated by a diet incorporating folate,
omega-3 fatty acids, olive oil, fish, fruits, vegetables and nuts. Boeing et al. also found
that older adults with depression were more likely to exhibit lower consumption of fruits
and vegetables. They identified that antioxidants from food sources were inversely
related to depression, but other forms of antioxidants were not (Boeing et al., 2012).
Finally, in a study by Florence, Asbridge, and Veugelers (2008), fruit and vegetable
intake was found to positively impact academic performance in children.
Lung diseases. Lung diseases may also be positively impacted by a diet high in
fruits and vegetables. Chatzi et al. (2007) observed an improvement in allergic symptoms
such as wheezing and rhinitis related to a diet high in fruits and vegetables. In addition,
30
Mendes, et al., (2011) found an inverse association between the regular consumption of
fruits during the most recent 30 days and the risk of having more severe asthma in
children. In a meta-analysis, it was reported that diets high in fruits especially, but also in
raw vegetables, were significantly associated with a lower risk of wheezing. The results
of this study also showed that consumption of vegetables in higher quantities decreased
the risk of asthma (Seyedrezazaeh, et al., 2014). Another study also reviewed previous
research about the intake of fruits and vegetables and the effect on lung diseases. Their
study found possible evidence of a negative association between fruit and vegetable
consumption and a decreased risk of asthma and COPD (Boeing et al., 2012).
Bone health. Research has investigated the impact of fruit and vegetable
consumption on bone health in a variety of ways. Studies may use osteoporosis,
osteoporotic fracture, bone mineral content, bone mineral density, or other bone
metabolism parameters as a measure of bone strength and stability. Boeing, et al. (2012)
found possible evidence that a high intake of fruits and vegetables may improve bone
health. Research investigating osteoporosis, osteoporotic fracture, bone density and bone
metabolism parameters produced inconsistent results causing the “possible evidence”
designation. Other studies reviewed for this research examined the impact of fruit and
vegetable intake during childhood as well as the influence of maternal intake during
pregnancy. These factors highlight the complexity of assessing the relationship between
diet and bone health.
A more recent study investigating adolescents, young, and postmenopausal
women found increased bone mineral density and bone mineral content in all three
groups significantly associated with higher fruit consumption. The effects were strongest
31
in boys and postmenopausal women (Li, et al., 2013). Conversely, Neville, et al. (2014)
investigated older adults and determined no significant difference in bone markers
between the group that significantly increased their fruit and vegetable intake and the
group that continued to consume two or fewer servings of produce per day. Similar to
the research by Boeing, et al. (2012), the results of these studies show that there is not
clear agreement about the relationship of fruits and vegetables on bone health.
Eye diseases and conditions. There are a variety of eye diseases and conditions
that may be influenced by the intake of fruits and vegetables, such as age-related macular
degeneration (AMD), glaucoma, cataracts, and diabetic retinopathy. Amirul Islam, et al.
evaluated how food frequency data related to AMD. Based on this data, it was
determined that a diet including high amounts of fruits, vegetables, chicken, and nuts
paired with limited red meat decreased the risk of advanced AMD (Amirul Islam, et al.,
2014). Less severe AMD was not associated with any particular pattern of consumption
(Amirul Islam, et al., 2014). Another study found a significant relationship between diet
and AMD based on Oriental (more fruits, vegetables, legumes, whole grains, tomatoes
and seafood) and Western (more red meat, processed meat, high-fat dairy, French fries,
refined grains, and eggs) dietary patterns. Participants in the study who consumed a diet
close to the Western diet had a greatly increased risk of AMD, whereas the odds of AMD
continued to decrease as the diet pattern moved closer to an Oriental diet (Chiu, et al.,
2014). Both of these studies associate improved conditions with dietary patterns
including fruits and vegetables as opposed to an association with fruits and vegetables
themselves. In contrast, Jonas, Nangia, Kulkarni, Gupta, and Khare (2012) discovered a
mildly significant relationship between AMD and a limited consumption of fruit.
32
All individuals with diabetes are at risk for diabetic retinopathy, and 40-45% of
diabetic Americans have been diagnosed with it. Mahoney and Loprenzi (2014)
determined that diabetic adults with a high intake of fruits and vegetables containing
flavonoids had a decreased risk of diabetic retinopathy. A higher fruit consumption
within a normal range of fruit intake and as a part of a low-fat, low-calorie diet was also
related to a lower incidence of diabetic retinopathy (Tanaka et al., 2013).
Furthermore, a smaller risk of glaucoma was found for older African-American
women when they consumed more fruits and vegetables with high concentrations of
vitamin A, vitamin C and carotenoids (Giaconi, et al., 2012). Additionally, Pastor-Valero
(2013) discovered an inverse association between fruit, vegetable, vitamin C and vitamin
E consumption on a regular basis and the risk of cataracts. The meta-analysis compiled
by Boeing, et al. found possible evidence that a higher intake of fruits and vegetables
may decrease the risk of macular degeneration and cataracts. Conversely, the evidence
was insufficient to show any effect of increased fruit and vegetable intake on the risk of
glaucoma or diabetic retinopathy (Boeing, et al., 2012).
Rheumatoid arthritis. A general review of factors impacting rheumatoid arthritis
(RA) concluded that characteristics of a healthy diet including fruits and vegetables may
be beneficial to patients with RA (O’Connor, 2013). Furthermore, a study of RA patients
with healthy arteries investigated how the intake of vegetables and fruits related to
arterial function (Crilly & McNeill, 2012). The results showed a relationship between
patients with better arterial function and the consumption of vegetables, but not fruits, on
a daily basis. Boeing, et al. (2012) also found possible evidence relating a high
33
consumption of produce with a lower risk of rheumatoid arthritis; this was only
considered possible evidence due to the limited number of studies available.
Overweight and obesity. A number of factors play a part in overweight and
obesity, including an imbalance between energy intake and energy expenditure. Intake of
fruits and vegetables are one factor, and their impact may be due to several different
causes. First of all, fruits and vegetables are lower in calories, and therefore, when
consumed in place of higher calorie foods, energy balance is improved. Based on the
studies reviewed by Rolls, et al. (2004), the authors suspect fruits and vegetables may
also impact weight management by decreasing hunger and increasing satiety.
Furthermore, fruits and vegetables are high in fiber compared to most other
foods, and epidemiologic studies have shown that people with higher fiber intakes are
more likely to have a lower body weight (Clark and Slavin, 2013). Davis, Hodges and
Gilham (2006) determined that study participants consuming a diet high in fiber, complex
carbohydrate, and fruit were more likely to have a normal amount of body fat and a
healthy weight based on their height. A systematic review determined that the majority
of studies reviewed found an inverse relationship between overweight/obese adults and
fruit and vegetable intake. However, the study did not identify whether that relationship
was due to the fruits and vegetables, decreased energy intake or increased activity levels
(Ledoux, Hingle & Baranowski, 2010).
Optimal Intake
Recommendations for optimal intake of fruits and vegetables differ slightly
among experts. The DGA make general recommendations, such as increasing the
consumption of fruits and vegetables and the variety of vegetables. The Guidelines also
34
suggest intake of foods that contain the nutrients most lacking in U.S. diets. Fruits and
vegetables are a significant contributor to these nutrients that are lacking (USDA, 2010).
Advice from other groups is more specific. On the ChooseMyPlate website, the
USDA recommends one and one-half to two cups of fruit per day and two to three cups
of vegetables per day for adults and one to two cups of fruit per day and one to three cups
of vegetables per day for children. The exact amount is determined by age and gender.
The USDA further specifies one and one-half to two cups of leafy green vegetables, four
to six cups of red and orange vegetables, one to two cups of beans and peas, four to six
cups of starchy vegetables, and three and one-half to five cups of other vegetables per
week for adults, thus identifying the need for a variety of fruits and vegetables to provide
diverse nutrients. For children, one-half to two cups of leafy green vegetables, two and
one-half to six cups of red and orange vegetables, one-half to two cups of beans and peas,
two to six cups of starchy vegetables and one and one-half to five cups of other
vegetables. The simplified version advises individuals to fill half of their nine-inch plate
with fruits and vegetables (USDA, n.d.).
Similarly, the Harvard School of Public Health (2015) suggests people on a 2000-
calorie per day diet aim for two cups of fruit and two and one-half cups of vegetables
(nine servings one-half cup servings). Furthermore, Health Canada’s Food Guide, last
updated in 2007, recommends seven to ten one-half cup (one cup for leafy greens) or one
piece servings of fruits and vegetables for adults, and four to eight servings for children.
Canadian recommendations are also determined based on age and gender (Health
Canada, 2007). Additionally, the World Health Organization (2004) suggests a minimum
of five servings (slightly over one-half cup) per day. The Australian government also
35
encourages five to seven and one-half servings of vegetables (one cup for leafy greens
and one-half cup for other vegetables) and two cup servings of fruit (one cup, one
medium piece, or two small pieces) (Australian Government Department of Health, n.d.).
Furthermore, recommendations in Japan include five to six servings of vegetables and
two servings of fruit per day (The Japan Dietetic Association, n.d.).
Current Intake
Results from the Behavioral Risk Factor Surveillance System in 2011 showed that
the national median for fruit intake was 1.1 times per day and 1.6 times per day for
vegetable intake. Moreover, 37.9% of people surveyed consumed fruit less than once per
day and 22.5% consumed vegetables less than once per day. Illinois responses were
similar, with the same medians for fruits and vegetables, but 36% of people surveyed
consumed fruit less than once daily, and 25% consumed vegetables less than once daily
(CDC, n.d.b). From 2011 to 2013, rather than improving, results actually declined
slightly. Both the national median and state median for fruits and vegetables remained the
same, as did the percent in Illinois who ate fruit less than once a day. However, 37.7% of
the national population reported consuming fruit less than once per day, and 22.6%
reported consuming vegetables less than once per day. In Illinois the percentage for
vegetables rose to 25.2% (CDC, 2013). This data indicates that current consumption is
moving toward smaller numbers of fruits and vegetables both nationally and locally.
Similarly, data from the USDA Economic Research Service shows a downward
trend in vegetable consumption. This data is not a direct measure of food consumption,
but is commonly used as an alternate method of comparing intake over time. Estimated
consumption of fresh-market vegetables (excluding potatoes, sweet potatoes, dry pulses
36
and mushrooms) has changed little since 2006. However, estimated fresh vegetable
intake in 2013 was 138.9 pounds, down from an average of more than 146 pound
between 2000 and 2009. Additionally, processed vegetables (excluding potatoes and
mushrooms) in 2013 decreased three percent compared to the average from 2010 to 2012.
Moreover, per capita use of a group of commercially produced, fresh vegetables,
processed vegetables, and dry pulses were 385.7 pounds in 2013, decreased from 424.6
pounds in 2000 (Economic Research Service, 2014).
Comparison Between Optimal and Current Intake
Clearly, there is a discrepancy between the recommended intake of fruits and
vegetables and the amount Americans are currently consuming, and that difference is
increasing (Economic Research Service, 2014). A large portion of the population is
consuming fruits and vegetables less than once per day, and the median for both types of
produce is less than two times per day (CDC, n.d.b). While it is possible that each time
fruit or vegetables are consumed, multiple servings are included, it is unlikely that many
people meet the recommended amounts (according to USDA, (n.d.), of as much as two
cups of fruit or three cups of vegetables) in one meal. Therefore, it seems probable that a
large number of Americans are not meeting their fruit and vegetable needs.
Possible Causes of Discrepancy Between Optimal and Current Intake
Several factors impacting fruit and vegetable intake by children and adolescents
were identified by Krolner, Rasmussen, Brug, Knut-Inge, Wind, and Due. First of all,
taste and preferences were determined to be an important factor, and the larger number of
fruits and vegetables children enjoyed (which appeared to be related to socio-economic
position and age), the higher their total consumption of fruits and vegetables was likely to
37
be. Sensory and physical attributes of produce, such as taste, texture, appearance, and
smell was another factor impacting children’s desire to eat fruit and vegetables.
Additionally, satiety may be a factor for some students. Krolner, et al. reported different
satiety responses to fruits and vegetables in different studies. Other factors determined to
have an impact included children’s expectations of fruits and vegetables impact on
satiety, health, appearance; children’s perceptions of appropriate time or setting for fruit
and vegetable intake; nutrition knowledge; difficulty, convenience and capability of
preparation; cost; availability of fruits and vegetables at home, at school, and locally; and
the influence of parents, peers and media Krolner, et al. (2011). Moreover, Ganann,
Fitzpatrick-Lewis, Ciliska, and Peirson, (2012) included lack of access to fruits and
vegetables, socioeconomic status of consumers, cost of produce, understanding of
nutrition, preferences and self-efficacy in their discussion of determinants of fruit and
vegetable consumption by children and adolescents.
In a study investigating 320 professional women aged 45 to 55, Gacek (2013)
identified a relationship between self-efficacy, optimism, life-satisfaction and a higher
level of fruit and vegetable intake, suggesting that the lack of strong self-efficacy,
optimism and satisfaction with life may be a barrier to appropriate levels of fruit and
vegetable consumption. Furthermore, Pitts, et al. (2013) discovered that there was no
association between college students who shopped at a farmer’s market and the
probability of consuming at least five servings of fruit and vegetables, but other
individuals shopping at a farmer’s market were much more likely to eat five or more
servings of fruits and vegetables daily. This signifies that limited access to fruits and
vegetables or limited access to a higher quality of fruits and vegetables may also reduce
38
the quantity individuals consume. Thornton, Crawford and Ball (2010) also determined
that those consuming fruit on a more frequent basis had access to venues selling fruits
and vegetables that operated for longer hours.
Older adults may have their own unique situations that present additional barriers
for fruit and vegetable consumption. Disease may affect taste preferences, mechanical
digestion and/or absorption, and shopping or preparation ability. A fixed income may
prevent purchase of more expensive forms of produce, thus limiting available options.
Nicklett and Kadell (2013) discussed a large number of factors negatively impacting fruit
and vegetable consumption, including changes in taste, smell and hunger awareness that
affect appetite; chewing, swallowing and digestive difficulties; mental and emotional
changes that may affect desire to eat or pleasure gained from food; and physical
limitations that make acquiring or preparing food difficult, frequently removing choice
from the individual when they need to rely on others for food provision.
Barriers may vary somewhat with age and stage of life, but some can be present
across the entire life-span. Socioeconomic status and access to fruits and vegetables are
factors that can impact any age group. Darmon and Drenewski (2008) determined that a
higher socioeconomic status increases the likelihood of fresh vegetable and fruit
consumption. Furthermore, Aggarwal, et al. (2014) found that individuals who shopped
at low-cost supermarkets had a significantly lower intake of fruits and vegetables than
those who shopped at supermarkets with higher prices, even after adjusting for
socioeconomic status. Thus, it may be that the availability of tempting fruit and vegetable
options in any form is more constrained at a low-cost supermarket, decreasing the
39
likelihood of purchasing and consuming a quantity of fruit and vegetables sufficient to
meet nutritional needs.
Community Supported Agriculture
Community supported agriculture (CSA) is a method of agricultural distribution
that brings together the farmer growing crops with customers who prefer to purchase
food directly from the farmer. The farmer generally offers shares of his farm outputs,
including produce, meat, poultry or eggs. In return, the farmer typically receives cash to
cover inputs such as the seed and labor required to grow and nurture the products. Most
CSAs offer a bag or box usually averaging between 8.5 and 27 pounds of produce
(Cohen, et al., 2012) available for pickup at a specified location and time on a weekly or
bi-weekly basis. Fruits and vegetables harvested are divided proportionately among the
shareholders, thus allowing any risks or rewards to be shared with the CSA members.
The CSA distribution model first appeared in the United States in the middle
1980’s (Janssen, 2010), and has become very popular during the last 20 years (Cohen, et
al., 2012). In some locations, the demand for a CSA share exceeds available membership
opportunities. Consequently, many CSAs have a waiting list of potential customers. No
governmental agency maintains data on CSAs, but LocalHarvest (2015) has a database
listing more than 4,000 CSA programs in the US.
Studies show that individuals who join a CSA share similar characteristics. Uribe,
et al. (2012) determined that participants of the CSA were older, had completed more
years of education, and had an income above the national average. Other research
indicates that women, as the primary shoppers of food (Zepeda & Li, 2007), are more
likely to participate in a CSA (Perez, Allex & Brown, 2003; Russell & Zepeda, 2008;
40
Uribe, et al., 2012; Curtis, Ward, Allen & Slocum, 2013). Curtis, et al. (2013) also found
that members were highly educated, but with average income levels and qualms about
health and food safety. Finally, Brehm and Eisenhauer (2008) found members of CSAs to
be supporters of environmental protection and sustainability.
Consumers choose to purchase a CSA membership for a variety of reasons. One
study found that participants join a CSA to support local agriculture, obtain healthier
food, and understand where their food is coming from and how it is produced (Landis, et
al., 2010). In addition, Cooley and Lass (1998) determined that, as well as a desire to
support local farms, individuals participated in a CSA for higher quality produce, safer
produce and a desire to promote environmental sustainability. Uribe, et al. (2012) found
in summarizing previous research studies that members perceived produce from a CSA to
be consistently safe, nutritious and superior in quality. Moreover, a study by Brehm and
Eisenhauer (2008) concluded that support for the community beyond agriculture was a
motivating factor for joining a CSA.
Research demonstrates that consumers who purchase a share of a CSA eat a wider
variety of fruits and vegetables (Cohen et al., 2012; Quandt, Dupuis, Fish & D’Agostino,
Jr., 2013).Furthermore, Uribe, et al. (2012) determined that most CSA shareholders and
their family members increased their consumption of fruits and vegetables due to their
participation in the CSA. Previous research reported similar results (Perez, et al., 2003;
Landis, et al., 2010). Some studies have also established that members of a CSA program
eat at home more frequently after joining the program (Perez, et al., 2003; Russell &
Zepeda, 2008; Curtis, et al., 2013).Additionally, many CSAs have an educational aspect,
allowing members the opportunity to learn about seasonality of produce, in addition to
41
cooking methods and preservation techniques (Curtis, et al., 2013), thus improving their
food preparation skills and increasing the likelihood of consuming adequate daily
servings of fruit and vegetables.
42
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54
APPENDIX A
RECRUITMENT EMAIL
Hi Everyone!
Fresh FAVs will be back in action this semester! I hope everyone is as excited as I am. I
wanted to personally email all of you to give you all of the information for signing up for
this semester.
Things are slightly different this time. We are now doing a small, medium, and large bag.
The pick-up times have also changed. Pick-up will continue to be on Fridays but the
times will be from noon-1:30 and 3:30-5pm.
For more information and the the registration form just follow this link:
http://wellness.illinoisstate.edu/healthy-living/nutrition/FreshFAVs.shtml
Try not to wait to the last minute to sign up. As of now there is not a cap on the number
of participants. However, if we get too many we may have to cap it and I would hate for
you to miss your chance to participate!
Please feel free to forward this information on to anyone at ISU that may want to
participate. Many of you have told me that other people in your office are wanting to
participate this time so make sure to share the news!
If you have any questions please do not hesitate to ask!
Erin Moses
55
APPENDIX B
CONSENT FORM
Consent Form
The Department of Family and Consumer Sciences’ Fresh FAVs Planning Committee
at Illinois State University is conducting a research study for the purpose of assessing
the dietary intake of participants.
Procedure: We are requesting your participation, which will involve completing an
online survey. Your time commitment will be approximately 10 minutes. At the
conclusion of the eight-week Fresh FAVs program, we will contact you to complete
another survey. The aggregate data will be analyzed for possible correlations.
Withdrawal: Your participation in this study is voluntary. If you choose not to
participate or to withdraw from the study at any time, you may do so without penalty.
Confidentiality: The results of the research study may be published, but your name
will not be used. All Information collected for the purpose of this study will remain
anonymous.
Risks: The minimal risks associated with this study are no greater than those
experienced in everyday life.
Benefits: Benefits of this study include helping the Fresh FAVs planning committee
understand the impact of the program.
If you have any questions concerning the research study, please call Dr. Julie
Schumacher at (309) 438-7031.
Sincerely,
Julie Schumacher, EdD, RD, LDN & Jeanne Arbuckle, Dietetic Intern
If you have any questions about your rights as a subject/participant in this research, or
if you feel you have been placed at risk, you can contact the Research Ethics &
Compliance Office at Illinois State University at (309) 438-2529.
56
1. Do you agree to participate in this study?*
Yes, I agree to participate in this study and am 18 years old or older
No, I do not agree to participate in this study or I am <18 years old
57
APPENDIX C
PRE-SURVEY
1. How many servings of fruit or 100% fruit juice do you eat per day? (OMIT fruit snacks
like Fruit Roll-Ups and fruit-on-the-bottom yogurt. One serving=one piece or 1/2 cup of
fruit or 6 oz. of fruit juice.)
(a) 0 -3
(b) less than 1 -2
(c) 1 0
(d) 2 +1
(e) 3 +2
(f) 4 or more +3
2. How many servings of non-fried vegetables do you eat per day? (One serving = 1/2
cup. INCLUDE potatoes.)
(a) 0 -3
(b) less than 1 -2
(c) 1 0
(d) 2 +1
(e) 3 +2
(f) 4 or more +3
3. How many servings of vitamin-rich vegetables do you eat per week? (One serving=1/2
cup. ONLY count broccoli, Brussels sprouts, carrots, collards, kale, red pepper, spinach,
sweet potatoes, or winter squash.)
(a) 0 -3
(b) 1 to 3 +1
(c) 4 to 6 +2
(d) 7 or more +3
4. How many servings or leafy green vegetables do you eat per week? (One serving = 1/2
cup cooked or 1 cup raw. ONLY count collards, kale, mustard greens, romaine lettuce,
spinach, or Swiss chard.)
(a) 0 -3
(b) less than 1 -2
(c) 1 to 2 +1
(d) 3 to 4 +2
(e) 5 or more +3
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5. How many times per week does your lunch or dinner contain grains, vegetables, or
beans, but little or no meat, poultry, fish, eggs, or cheese?
(a) 0 -1
(b) 1 to 2 +1
(c) 3 to 4 +2
(d) 5 or more +3
6. How many times per week do you eat beans, split peas, or lentils? (OMIT green
beans.)
(a) 0 -3
(b) less than 1 -1
(c) 1 0
(d) 2 +1
(e) 3 +2
(f) 4 or more +3
7. How many servings of grains do you eat per day? (One serving= 1 slice of bread, 1 oz.
of crackers, 1 large pancake, I cup pasta or cold cereal, or 1/2 cup granola, cooked cereal,
rice, or bulgur. OMIT heavily sweetened cold cereals.)
(a) 0 -3
(b) 1 to 2 0
(c) 3 to 4 +1
(d) 5 to 7 +2
(e) 8 or more +3
8. What type of bread, rolls, etc., do you eat?
(a) 100% whole wheat as the only flour +3
(b) whole wheat flour as the 1st or 2
nd flour +2
(c) rye, pumpernickel, or oatmeal +1
(d) white, French, or Italian 0
9. What kind of breakfast cereal do you eat?
(a) whole-grain (like oatmeal or Wheaties) +3
(b) low-fiber (like Cream of Wheat or Corn Flakes) 0
(c) sugary low-fiber (like Frosted Flakes) or low-fat granola -1
(d) regular granola -2
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MEAT, POULTRY & SEAFOOD
10. How many times per week do you eat high-fat red meats (hamburgers, pork chops,
ribs, hot dogs, pot roast, sausage, bologna, steaks other than round steak, etc.)?
(a) 0 +3
(b) less than 1 +2
(c) 1 -1
(d) 2 -2
(e) 3 -3
(f) 4 or more -4
11. How many times per week do you eat lean red meats (hot dogs or luncheon meats
with no more than 2 grams of fat per serving, round steak, or pork tenderloin)?
(a) 0 +3
(b) less than 1 +1
(c) 1 0
(d) 2-3 -1
(e) 4-5 -2
(f) 6 or more -3
12. After cooking, how large is the serving of red meat you eat? (To convert from raw to
cooked, reduce by 25 percent. For example, 4 oz. of raw meat shrinks to 3 oz. after
cooking. There are 16 oz. in a pound.)
(a) 6 oz. or more -3
(b) 4 to 5 oz -2
(c) 3 oz. or less 0
(d) don’t eat red meat +3
13. If you eat red meat, do you trim the visible fat when you cook or eat it?
(a) yes +1
(b) no -3
14. What kind of ground meat or poultry do you eat?
(a) regular ground beef -4
(b) ground beef that’s 11% to 25% fat -3
(c) ground chicken or 10% fat ground beef -2
(d) ground turkey -1
(e) ground turkey breast +3
(f) don’t eat ground meat or poultry +3
15. What chicken parts do you eat?
(a) breast +3
(b) drumstick +1
(c) thigh -1
(d) wing -2
(e) don’t eat poultry +3
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16. If you eat poultry, do you remove the skin before eating?
(a) yes +2
(b) no -3
17. if you eat seafood, how many times per week? (OMIT deep-fried foods, tuna packed
in oil, and mayonnaise-laden tuna salad—low-fat mayo is okay.)
(a) less than 1 0
(b) 1 +1
(c) 2 +2
(d) 3 or more +3
MIXED FOODS
18. What is your most typical breakfast?
(a) biscuit sandwich or croissant sandwich -4
(b) croissant, Danish, or doughnut -3
(c) eggs -3
(d) pancakes, French toast, or waffles -1
(e) cereal, toast, or bagel (no cream cheese) +3
(f) low-fat yogurt or low-fat cottage cheese +3
(g) don’t eat breakfast 0
19. Does your typical breakfast also include sausage?
(a) yes -3
(b) no 0
(c) don’t eat breakfast 0
20. What sandwich fillings do you eat?
(a) regular luncheon meat, cheese, or egg salad -3
(b) tuna or chicken salad or ham -2
(c) peanut butter 0
(d) roast beef +1
(e) low-fat luncheon meat +1
(f) tuna or chicken salad made with fat-free mayo +3
(g) turkey breast or hummus +3
21. What do you order on your pizza?
(a) no cheese with at least one vegetable topping +3
(b) cheese with at least one vegetable topping -1
(c) cheese -2
(d) cheese with one meat topping -3
(e) don’t eat pizza +3
61
22. Do you order extra cheese?
(a) yes -1
(b) no 0
(c) don’t eat breakfast 0
23. Do you order a cheese-filled crust?
(a) yes -1
(b) no 0
(c) don’t eat breakfast 0
24. Do you order more than one meat topping?
(a) yes -1
(b) no 0
(c) don’t eat breakfast 0
25. What do you put on your pasta?
(a) tomato sauce or red clam sauce +3
(b) meat sauce or meat balls -1
(c) pesto or another oily sauce -3
(d) Alfredo or another creamy sauce -4
26. Do you add sautéed vegetables to your pasta?
(a) yes +1
(b) no 0
(c) don’t eat pasta 0
27. How many times per week do you eat deep-fried foods (fish, chicken, 61auté61 fries,
potato chips, etc.)?
(a) 0 +3
(b) 1 0
(c) 2 -1
(d) 3 -2
(e) 4 or more -3
28. At a salad bar, what do you choose?
(a) nothing, lemon, or vinegar +3
(b) fat-free dressing +2
(c) low- or reduced-calorie dressing +1
(d) oil and vinegar -1
(e) regular dressing -2
(f) cole slaw, pasta salad, or potato salad -2
(g) cheese or eggs -3
62
29. How many times per week do you eat canned or dried soups or frozen dinners?
(OMIT lower-sodium, low-fat ones.)
(a) 0 +3
(b) 1 0
(c) 2 -1
(d) 3 to 4 -2
(e) 5 or more -3
30. How many servings of low-fat calcium-rich foods do you eat per day? (One
serving=2/3 cup low-fat or non-fat milk or yogurt, 1 oz. low-fat cheese, 1 1/2 oz.
sardines, 3 1/2 oz. canned salmon with bones, 1 oz. tofu made with calcium sul-fate, 1
cup collards or kale, or 200 mg of a calcium supplement.)
(a) 0 -3
(b) less than 1 -1
(c) 1 +1
(d) 2 +2
(e) 3 or more +3
31. How many times per week do you eat cheese? (INCLUDE pizza, cheeseburgers,
lasagna, tacos or nachos with cheese, etc. OMIT foods made with low-fat cheese.)
(a) 0 +3
(b) 1 +1
(c) 2 -1
(d) 3 -2
(e) 4 or more -3
32. How many egg yolks do you eat per week? (ADD 1 yolk for every slice of quiche
you eat.)
(a) 0 +3
(b) 1 +1
(c) 2 0
(d) 3 -1
(e) 4 -2
(f) 5 or more -3
FATS & OILS
33. What do you put on your bread, toast, bagel, or English muffin?
(a) stick butter or cream cheese -4
(b) stick margarine or whipped butter -3
(c) regular tub margarine -2
(d) light tub margarine or whipped light butter -1
(e) jam, fat-free margarine, or fat-free cream cheese 0
(f) nothing +3
63
34. What do you spread on your sandwiches?
(a) mayonnaise -2
(b) light mayonnaise -1
(c) catsup, mustard, or fat-free mayonnaise +1
(d) nothing +2
35. With what do you make tuna salad, pasta salad, chicken salad, etc?
(a) mayonnaise -2
(b) light mayonnaise -1
(c) fat-tree mayonnaise 0
(d) low-fat yogurt +2
36. What do you use to sauté vegetables or other foods? (Vegetable oil includes
safflower, corn, sunflower, and soybean.)
(a) butter or lard -3
(b) margarine -2
(c) vegetable oil or light margarine -1
(d) olive or canola oil +1
(e) broth +2
(f) cooking spray +3
BEVERAGES
37. What do you drink on a typical day?
(a) water or club soda +3
(b) caffeine-free coffee or tea 0
(c) diet soda -1
(d) coffee or tea (up to 4 a day) -1
(e) regular soda (up to 2 a day) -2
(f) regular soda (3 or more a day) -3
(g) coffee or tea (5 or more a day) -3
38. What kind of “fruit” beverage do you drink?
(a) orange, grapefruit, prune, or pineapple juice +3
(b) apple, grape, or pear juice +1
(c) cranberry juice blend or cocktail 0
(d) fruit “drink,” “ade,” or “punch” -3
39. What kind of milk do you drink?
(a) whole -3
(b) 2% fat -1
(c) 1% low-fat +2
(d) skim +3
64
DESSERTS & SNACKS
40. What do you eat as a snack?
(a) fruits or vegetables +3
(b) low-fat yogurt +2
(c) low-fat crackers +1
(d) cookies or fried chips -2
(e) nuts or granola bar -2
(f) candy bar or pastry -3
41. Which of the following “salty” snacks do you eat?
(a) potato chips, corn chips, or popcorn -3
(b) tortilla chips -2
(c) salted pretzels or light microwave popcorn -1
(d) unsalted pretzels +2
(e) baked tortilla or potato chips or
homemade air-popped popcorn +3
(f) don’t eat salty snacks +3
42. What kind of cookies do you eat?
(a) fat-free cookies +2
(b) graham crackers or reduced-fat cookies +1
(c) oatmeal cookies -1
(d) sandwich cookies (like Oreos) -2
(e) chocolate coated, chocolate chip, or peanut butter -3
(f) don’t eat cookies +3
43. What kind of cake or pastry do you eat?
(a) cheesecake -4
(b) pie or doughnuts -3
(c) cake with frosting -2
(d) cake without frosting -1
(e) muffins 0
(f) angelfood, fat-free cake, or fat-free pastry +1
(g) don’t eat cakes or pastries +3
44. What kind of frozen dessert do you eat?
(a) gourmet ice cream -4
(b) regular ice cream -3
(c) frozen yogurt or light ice cream -1
(d) sorbet, sherbet, or ices -1
(e) non-fat frozen yogurt or fat-free ice cream +1
(f) don’t eat frozen desserts +3
65
45. Do you add hot fudge topping to your frozen dessert?
(a) yes -1
(b) no 0
46. Do you add nuts to your frozen dessert?
(a) yes -1
(b) no 0
47. Do you add chocolate candy bars or pieces to your frozen dessert?
(a) yes -1
(b) no 0
48. What is your connection to ISU?
(a) undergraduate student
(b) graduate student
(c) faculty
(d) staff
(e) retiree
49. What is your home department or unit on campus?:
50. What is your gender?
(a) female
(b) male
51. In what range does your age fall?
(a) 18-27
(b) 28-37
(c) 38-47
(d) 48-57
(e) 58-67
(f) 68 or older
52. Please pick a 4 digit code that you will remember when you complete this survey
again at the end of the Fresh FAVs Spring 2014 session.
66
APPENDIX D
ADDITIONAL POST-SURVEY QUESTIONS
On a scale of 1-5 with 1=Strongly Disagree and 5=Strongly Agree, please rate the
following statements:
1. Fresh FAVs had a positive effect on my attitude about produce.
2. Fresh FAVs inspired me to consume more fruits and vegetables.
3. Fresh FAVs inspired me to consume more healthy foods.
4. Fresh FAVs inspired me to locate and use new recipes.
5. Fresh FAVs inspired me to learn new methods of cooking.
6. After participation in Fresh FAVs, I will continue to consume a wider variety of
produce than before participating in the program.
What did you like best about the Fresh FAVs Program?
What suggestions for improvement do you have for the Fresh FAVs Program?